From the Research
Patients with vertebral artery dissection and occlusion complicated by hypotension should generally wait at least 4-6 weeks before undertaking long-distance air travel, though individual cases may require longer recovery periods. This recommendation is based on the need for the patient to be medically stable and to have completed the initial high-risk period for stroke or extension of dissection 1.
Key Considerations
- Before flying, patients should be medically stable with controlled blood pressure (neither hypertensive nor hypotensive) for at least 1-2 weeks.
- Patients should have completed the initial high-risk period for stroke or extension of dissection.
- Prior to travel, patients should consult with their neurologist or vascular specialist for personalized clearance.
- Most patients will be on antithrombotic therapy (either antiplatelet agents like aspirin 81-325mg daily or clopidogrel 75mg daily, or anticoagulants like warfarin with INR 2-3 or direct oral anticoagulants) which should be continued during travel.
In-Flight Precautions
- During the flight, patients should stay well-hydrated, avoid alcohol, perform frequent leg exercises, wear compression stockings, and take short walks when possible.
- The cabin pressure changes and prolonged immobility during flights increase risks of both hypotension episodes and thromboembolic events, which are particularly dangerous for someone recovering from arterial dissection.
- If symptoms like severe headache, neck pain, dizziness, visual disturbances, or weakness occur during the flight, medical attention should be sought immediately.
Evidence Basis
The most recent and highest quality study 1 supports the use of endovascular therapy for acute basilar artery occlusion caused by vertebral artery dissection, highlighting the importance of prompt and effective treatment to prevent further complications. While this study does not directly address the timing of air travel after vertebral artery dissection, it underscores the need for careful management and monitoring of patients with this condition.
Clinical Decision Making
In the context of real-life clinical medicine, it is essential to prioritize caution and consider the individual patient's risk factors, medical history, and current condition when making decisions about air travel after vertebral artery dissection. The patient's neurologist or vascular specialist should be consulted for personalized clearance and guidance on the safest approach to air travel.